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Ohio law no longer stands in the way of federal recommendations to increase routine HIV tests,
even on those Americans not considered at high risk.

The federal Centers for Disease Control and Prevention began calling for more widespread
screening five years ago. But until recently, Ohio law created obstacles to boosting the numbers
here.

A new state law aimed at clearing those obstacles was enacted in 2009, and rules on how to
follow it were issued by the Ohio Department of Health this past fall.

Previously, "essentially the patient had to get down on their knees and beg for the test," said
Dr. Ron Reynolds, a suburban Cincinnati family physician who pushed for the change.

The problem now is that many doctors don't know about the changes, he said.

Under the old law, doctors had to consult with patients about HIV testing in advance and get
separate consent to run other tests. That could take 20 minutes, Reynolds said. After HIV tests,
doctors had to have another consultation with their patients, even if a test result was
negative.

Now, no separate consent is required, and consultations aren't mandatory if doctors run tests
after routine appointments or a hospitalization and find nothing. Patients still know that their
doctors are running the test and agree to it.

"An HIV test can now legitimately be handled just like a blood-sugar test or cholesterol test,"
Reynolds said.

Changes such as the one in Ohio are important steps in increasing testing, said Dr. Bernard
Branson, associate director of the CDC's Division of HIV/AIDS Prevention.

In 2006, about 20 states had laws similar to Ohio's old law, he said. Now, four do.

In some cases, states have gone beyond eliminating barriers and instituted policies that
increase testing. In New York, doctors and hospitals must offer patients HIV tests under a law
signed last year.

An estimated 1.1 million Americans are infected with HIV, but one in five doesn't know it.

Last year, the CDC reported that 55 percent of adults - including the 28 percent with a known
risk factor - had not been tested.

Those who don't know they are infected are more than three times as likely to pass the disease
to someone else, Branson said.

The problem is of particular concern for African-American women, who have a much higher risk of
contracting the disease, often from their spouse or partners involved in other sexual
relationships, including those with other men.

Dr. Michael Para, an HIV expert at Ohio State University Medical Center, said he expects that
the law change will increase testing a bit, but the benefits will be limited without physician
education.

"We basically have to change physicians' ideas, and that happens slowly," he said.

Para said that counseling after negative test results is still important for those who are at
increased risk because that's an opportunity to talk about prevention.

Government-supported testing sites, including those at health departments, still are required to
offer counseling after a negative test, said Bill Tiedemann, who heads the Ohio Department of
Health program focused on HIV prevention.

The new law "doesn't reduce someone's confidentiality around their health information; what it
does is reduce the barriers at the clinical level," he said.

In 2010, the state health department was awarded a $1.18 million, three-year grant to expand
testing. It hopes to increase the number of tested Ohioans by 53,000 in that time. Five emergency
departments at hospitals across the state will get grants to start routine testing.

If your doctor doesn't approach you about a test, bring it up, said the CDC's Branson. "A lot of
physicians are fearful that their patients might take offense."